INFORMATION AND OPPORTUNITIES

** The International Society of Behavioral Nutrition and Physical Activity (ISBNPA) will host its 15th meeting in Cape Town, South Africa on 8-11 June 2016. For more information, see http://isbnpa2016.org/

** The 53rd International Making Cities Liveable Conference will be held in Rome and Vatican City 13-17 June 2016. Abstract proposals are due by 20 December 2015. For more information, see http://www.livablecities.org/conferences/53rd-conference-rome/call-papers

** Walk21 Hong Kong will be the first Walk21 international walking conference held in Asia. The conference is scheduled for 3-7 October 2016. For more information about the conference, the call for papers (which will be announced shortly!), and registration, see: http://walk21hk.com/index.html

** World Day of Physical Activity: mark your calendars for 6 April 2016. This year’s theme is Active Child: Healthy Adult!

** The report "Achieving 25 x 25 through Civil Society Coalitions" was launched recently at the first-ever Global NCD Alliance Forum. The NCD Alliance commissioned the independent situational analysis of national and regional NCD alliances in the lead-up to the Forum. The full report can be found here.

** On 24 September 2015, world leaders formally adopted the 2030 Agenda for Sustainable Development. For the first time, NCDs are included in UN goals as a sustainable development priority for all countries. More information can be found here.

** For other updates and upcoming events, please see the NCD Alliance news and events sites: http://www.ncdalliance.org/news and

http://www.ncdalliance.org/events

Physical Activity, NCDs, and Poverty

The relationship between physical activity and NCDs is well established: insufficient physical activity is one of the ten leading risk factors for global mortality. According to the WHO, “People who are insufficiently physically active have a 20% to 30% increased risk of all-cause mortality compared to those who engage in at least 150 minutes of moderate intensity physical activity per week...Regular physical activity reduces the risk of ischaemic heart disease, diabetes, breast and colon cancer. Additionally, it lowers the risk of stroke, hypertension, and depression. Furthermore, physical activity is a key determinant of energy expenditure and [is] thus fundamental to energy balance and weight control.”1

Globally, almost one-quarter of adults over the age of eighteen are insufficiently active, with rates of inactivity being higher among women than men, and among older adults than younger ones. Residents of high-income countries also have more than double the prevalence of low physical activity compared to those living in low-income countries. WHO suggests that this may be explained by “increased work and transport-related physical activity” in low- and lower-middle-income countries and “the increased automation of work and life” in higher-income countries.2

However, such statistics mask the relationship that exists between low physical activity and poverty. In this issue, we explore the problem of low

physical activity levels in low-income countries and among the very poor. We also look at whether and how governments in low-income countries can provide the infrastructure that is necessary to encourage and enable people to be more active.

We also explore HealthBridge’s recent work on the preservation and management of neighbourhood parks and playgrounds in

inner-city Hanoi. We hope that this work will prove to be inspirational!

1 World Health Organization, “Prevalence of insufficient physical activity,” http://www.who.int/gho/ncd/risk_factors/physical_activity_text/en/

2 Ibid.

NCD and Poverty Research NetworkNCD and Poverty Research Network Exploring the multi-dimensional relationships between non-communicable diseases and poverty

2015 — Issue 7 page 1

People who are insufficiently physically active have a 20% to 30% increased risk of early mortality.

Poverty and Physical Activity

The relationship between poverty and physical activity is complicated. In low-income countries, obesity and lack of physical activity are more common among the wealthy than among the poor. Many of the poor, where they have jobs, are employed in the informal sector doing physically challenging work. This includes male-dominated jobs like construction, transportation, and manufacturing work. On the other hand, some jobs – such as bidi-rolling and sewing which are typically dominated by women – are physically challenging in the sense that they require long hours with very little active movement at all. In some countries, this division of labour (combined with traditional cultural norms) means that women may get far less physical activity than do men. For example, just over ten percent of men in Bangladesh do not get enough physical activity, compared to more than forty percent of women.1 Thus, while lack of physical activity is a greater problem among the rich, its pernicious effects extend to the poor who also have less access to sound medical advice and treatment.

At the same time, though, much of the regular “household work” undertaken by poor women around the world involves hard physical labour, such as carrying heavy water buckets and collecting large loads of fuel wood. As one recent report noted, “Housework in developing countries...consists of continuous, difficult physical labor...Most families can't afford modern appliances, so [a woman’s] cooking and cleaning tasks must be done by hand—crushing corn into meal with heavy rocks, scrubbing laundry against rough stones, kneading bread and cooking gruel over a blistering open fire.”2

Physically challenging work — whether informal sector work or household work — does not give the health benefits that come from physical activity. Nor are all types of physical activity created equal. Some contribute to better health while others are likely to result in injury. Health status can actually decline as a result of long hours of demanding physical labour. Furthermore, intense physical labour may be detrimental to women’s reproductive health, with a number of research studies suggesting that overly strenuous physical activity may be linked to low infant birth weight and pregnancy weight gain, shorter gestation, congenital malformations, and other pregnancy-related problems.3 It is an important responsibility of governments to increase opportunities for people to engage in health-promoting physical activity while simultaneously protecting workers from the types of physically strenuous labour that are most likely to result in injury or disease.

1 Bangladesh NCD Risk Factor Survey 2010. Bangladesh Society of Medicine, World Health Organization, N.C.D. Directorate Generate of Health Services, Ministry of Health and Family Welfare. 2 Julie Mullins, “Gender Discrimination: Why is it still so bad and what can you do about it?” http://childreninneed.com/magazine/gender.html 3 S. Rao et al., “Maternal activity in relation to birth size in rural India: The Pune Maternal Nutrition Study.” European Journal of Clinical Nutrition 57, no. 4 (April 2003): 531-42; Z. Lukmanji, “Women's workload and its impact on their health and nutritional status.” Progress in Food and Nutrition Science 16, no. 2 (1992): 163-79; A Peterman et al. “Managing the double burden: pregnancy and labor-intensive time use in rural China, Mexico, and Tanzania.” Studies in Family Planning 44, no. 4 (December 2013): 411-30.

2015 — Issue 7 page 2

NCD and Poverty Research NetworkNCD and Poverty Research Network Exploring the multi-dimensional relationships between non-communicable diseases and poverty

Not all types of physical activity are created equal. Some — like the physically demanding labour typically undertaken by the poor — is more likely to contribute to injury than to better health.

Preserving Hanoi’s Parks and Playgrounds

Urbanization in Viet Nam is happening faster than elsewhere in the region. By 2020, some 45% of the country’s population will live in cities, compared to 30% in 2009. Ha Noi’s city boundaries are already three times larger than they were in 2008. While such rapid urbanization provides numerous opportunities for economic development, it also strains attempts to ensure that local residents have access to open green spaces for recreation. This is particularly problematic for people living in the historical inner-city districts, where ongoing in-fill and rebuilding projects take precedence over parks and playgrounds.

HealthBridge recently concluded a situational analysis of the current state of Ha Noi’s neighbourhood parks and playgrounds. Funded by The Asia Foundation, the project team also developed a practical strategy through which the government could increase the number and quality of local parks and playgrounds in the city.1 The project focused in particular on Ha Noi’s nine oldest neighbourhoods located in the urban core. It addressed all open public spaces that are, or can potentially be, used for people living nearby to relax, do exercise, play and interact, such as flower gardens, playgrounds, walking paths around ponds/lakes, and other unused public land plots.

The study found that the Ha Noi city government has been pro-active in making the city green and healthy for its citizens, and has already adopted a number of policies that address the need for local parks, playgrounds, and sport yards. The Ha Noi Greenery Planning, for example, aims to turn Ha Noi into a green and clean city, reduce pollution levels, and improve the quality of life for Hanoians. However, other urbanization policies directly contradict or over-rule measures designed to create and maintain public green space. Too many different departments are responsible for different aspects of land planning to allow any coherent approach to be implemented. There are no adequate policy measures (including budgets) in place to help the government achieve its stated targets related to green space and public recreation facilities. In addition, the policies focus almost exclusively on new urban areas at the expense of older neighbourhoods, where it would be almost impossible to implement new planning regulations. There is little transparency in the management of public lands, and a lack of reliable statistics on where public land is located or how it is being used. Local residents have no voice in local planning initiatives, and NGOs focus on the larger green spaces rather than on local parks. As a result, public land has been shrinking, taken up for housing and other private use, and safe neighbourhood parks and playgrounds are disappearing, degrading, or never being created.

The picture was not all bleak, however. In several neighbourhoods, local residents worked together to refurbish and revitalize their open spaces and parks, making them safe playgrounds for people of all ages. HealthBridge drew upon the experiences of people in those neighbourhoods to demonstrate that it is possible to create attractive, accessible, outdoor social places in the often poor inner-city areas where local residents can interact and improve their physical and mental health.

1 HealthBridge, Urban Governance in Preservation and Management of Neighborhood Parks/Playgrounds in Inner-City District of Hanoi. Full report available at: http://healthbridge.ca/images/uploads/library/neighborhood_park_report.pdf

2015 — Issue 7 page 3

NCD and Poverty Research NetworkNCD and Poverty Research Network Exploring the multi-dimensional relationships between non-communicable diseases and poverty

It is possible to create attractive, accessible, outdoor social places in the often poor inner-city areas where local residents can interact and develop their physical and mental health.

Poorly managed playgrounds in Ha Noi’s Van Chuong ward

Community efforts to revitalize local spaces in Thuong Dinh and Bai Giua: Before and After

Encouraging Government Investment in Physical Activity Infrastructure

Increasing levels of healthy physical activity – both the amount of activity per person and the total number of people engaging in it each day – requires appropriate physical infrastructure. Personal motivation is not enough. It is difficult for people to find the time or the place to engage in physical activity outside of their regular schedules and responsibilities. The best way to ensure that most people in any given society will be able to participate in healthy physical activity is to provide high quality opportunities for active transport (such as walking and cycling) and play. In this way, healthy exercise becomes part of people’s daily routine, rather than an additional activity. Attractive public spaces that are free for all are critical, as they facilitate both physical health (filled, as they often are, with walkers, joggers, cyclists, and people playing various sports and games) and mental health (places to have fun and socialize).

How can governments in low-income countries afford to provide high quality environments that encourage healthy physical activity? The better question, is how can they afford not to? The cost of treating preventable NCDs is skyrocketing; reducing the incidence of costly NCDs that result from a lack of physical activity is clearly needed to keep those costs from rising further. There are a variety of options available for integrating low-cost, basic infrastructure into existing planning processes. For example, footpaths, zebra crossings/signed intersections, and cycle paths all foster safe and active transport. Similarly, public neighbourhood parks ensure that people living nearby have ready access to healthy outdoor recreation. Heavy lobbying by car, fuel, and road building companies and pressure from international institutions for mega projects often drive governments’ decision-making processes. The problem, therefore, is not always a shortage of funds, but rather a failure to prioritize access to healthy and safe physical activity over other types of infrastructure. Strengthening civil society’s voice is thus critical for encouraging government investment in safe and healthy physical activity.

In addition to the obvious argument that safe physical activity infrastructures could reduce preventable NCDs, and the costs associated with them, other solid points for more government investment in active transport and public spaces include:

Mental health There is a direct link between exercise and mental health: being physically active can help to reduce depression, anxiety, and stress, while improving sleep.

Transport expenditures The poor can spend a large portion of their income on transport. Improving cycling infrastructure may help to decrease these expenditures while simultaneously providing access to increased physical activity.

Job creation Better infrastructure for walking and cycling can result in more local jobs for the manufacture, repair, and servicing of bicycles (and shoes).

Environment Motorized vehicles emit pollutants, are noisy, and make the roads dangerous for pedestrians and cyclists. Active modes of transport do none of these things, while also providing safe and healthy exercise. At the same time, neighbourhood parks and playgrounds provide healthy environments in which people can relax, play, and enjoy natural greenery and fresh air.

People with Disabilities Travelling around a typical low-income city, which offers few transportation options, can be extremely difficult for people with intellectual or physical disabilities. Improving active transport infrastructure could improve mobility for all.

Neighbourhood cohesiveness Small local parks and playgrounds, located within a short walk or bike ride, attract local residents on a much more regular basis than do larger parks located further away. This helps people to get to know their neighbours and to create a neighbourhood identity.

2015 — Issue 7 page 4

NCD and Poverty Research NetworkNCD and Poverty Research Network Exploring the multi-dimensional relationships between non-communicable diseases and poverty

The best way to ensure that most people will be able to participate in healthy physical activity is to provide high quality opportunities for active transport and play.

NCD AND POVERTY RESEARCH NETWORK

The NCD and Poverty Research Network is a virtual network of researchers, advocates, and other individuals interested in exploring the links between non-communicable diseases and poverty.

Initiated in 2009 as the Tobacco and Poverty Network, the network includes members from countries throughout Asia, Africa, and the Americas. In 2013, its focus expanded to include non-communicable diseases.

The purpose of the network is to provide a collegial forum through which researchers, advocates, and others working in NCD prevention and control can share research results, ideas, experiences, challenges, and solutions for exploring and addressing issues related to NCDs and poverty.

The network is moderated by HealthBridge, and network emails are disseminated regularly. Network members may distribute information to the network by sending an email to Lori Jones, ljones@healthbridge.ca

We look forward to your contributions and feedback!

ANNOUNCEMENTS

Do you have any announcements that you would like to share with the network? Let us know by sending an email to Lori Jones ljones@healthbridge.ca

Foundation of Canada

Head Office: 1004 – One Nicholas St.

Ottawa, ON Canada K1N7B7

Tel: 1-(613) 241-3927; Fax: 1‐(613) 241‐7988;

Email: admin@healthbridge.ca; Web: www.healthbridge.ca

2015 – Issue 7 page 5

Networking

There are a number of individuals and organizations around the world that are currently engaged in promoting, building, saving, and demanding accessible outdoor public spaces for physical activity and recreation. We’ve noted just a few of them here.

HealthBridge’s Livable Cities programme seeks to improve the livability of cities by ensuring access for the most vulnerable to healthy transportation, healthy foods, and parks and public spaces. A series of video blogs, as well as newsletters and information about recent projects and other activities can be found here. The HealthBridge website also has blogs specifically about walking, exercise, public spaces, and urban planning.

In London England, the Museum of Walking designs and hosts walking events, while podcasts about being inspired by walking can be found here.

The Global Physical Activity Network shares information about the latest research developments, careers, and events related to the benefits of physical activity. Its Conference and Training centre provides information about upcoming global physical activity events, conferences and training opportunities.

The Physical Activity Network of the Americas (RAFA/PANA), a “network of national networks,” aims to improve, recover, maintain and promote good health and quality of life in the Americas through regular physical activity practice.

The European Network for the Promotion of Health-Enhancing Physical Activity (HEPA) works for better health through physical activity among all people in the WHO European Region, by strengthening and supporting efforts to increase participation and improve the conditions for healthy lifestyles.

The Agita Mundo Network seeks to promote physical activity as a healthy behavior for people all around the world. It stimulates research, encourages the dissemination of information on the health benefits of physical activity and effective strategies to increase physical activity, advocates for physical activity and health, and supports the development of national and local programs and networks for physical activity promotion.

The African Physical Activity Network (AFPAN) aims to establish communication between physical activity advocates, practitioners, and policy makers throughout Africa to promote and strengthen initiatives regarding physical activity and a healthy society.

Why not let us know what you are doing?

NCD and Poverty Research NetworkNCD and Poverty Research Network Exploring the multi-dimensional relationships between non-communicable diseases and poverty